Neuro E1 Flashcards by Macy Meng

Primary Headache Disorders 4

Migraine
Tension-Type Headache
Cluster Headache
Hemicrania Continua

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Secondary Headache Disorders 7

Traumatic Brain Injury Headache
Pseudotumor Cerebri
Brain Tumor Headache
Reversible Cerebral Vasoconstriction Syndrome
Subarachnoid Headache
Medication Overuse Headache
Substance Withdrawal Headache

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Migraine Aura Chateristics

Gradual onset/evolution of positive visual symptoms (shimmering lights, zigzags in vision, tingling)
Sequential progression (positive symptoms first then negative symptoms) OR repetitive attacks of identical nature
Flurry of attacks midlife
<60mins
50% chance HA follows

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Transient Ischemic Attack (TIA)

Abrupt visual loss
Simultaneous occurance of multiple neurological symptoms (vision loss and arm feeling numb at the same time)
< 15 mins
HA does not accompany

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Diclofenac potassium oral solution (Cambia)

Solution NSAID (faster absp)
Needs to be mixed with 1 - 2 oz of water prior to admin

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Celecoxib oral solution (Elyxyb)

Solution NSAID (faster absp)

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Butalbital/APAP/Caffeine (Fioricet, Bac, Esgic, Zebutal)

NON CONTROLLED
Butalbital is a barbiturate, thus abuse potential
BBW for hepatotoxicity because of APAP
Can depress sensory cortex/alter cerebela function
LAST LINE TX MEDICATION OVERUSE HEADACHE, limit to 3days/month

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Butalbital/ASA/Caffeine (Fiorinal)

C3
LAST LINE TX MEDICATION OVERUSE HEADACHE, limit to 3days/month

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Triptans use and CI in what

FOR ACUTE TREATMENT ONLY, early administration for best response

Contraindicated in stroke/tia patients (so if s/sx show history then don’t use), no use within 24hrs of an ergot

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Simple Partial Seizures Definition

NO impairement of consciousness
Associated with motor signs, sensory and somatosensory signs, autonomic signs

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Complex partial seizures Definition

WITH impairment of consciousness, not LOSS of consciousness
Patient may present as if with a psych disorder

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Generalized Seizures Definition

Tonic-clonic (involuntary muscle loss - convulsing)
All of the cerebral cortex is involved, a CORTICOL event

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Abscence Seisures Definition

Only happens in childhood and early adolescence

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Difference between Seizure and Epilepsy

Epilesy is a disorder of continued seizures

If seizures are caused as a side effect of recrational and illegal meds then it can progress to epilepsy.

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Prego OK Seizure Rx

PLFEO (pregnant ladies feel especially obese)

Phenobarbital (a barbituate so expect baby to withdraw)
Oxcarbamazepine
Lamotrigine
Ethosuximide
Folic Acid Supplement

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Nursing NOT OK Seizure Rx

Phenobarbital because the baby can become addicted

All other drugs actual newborn dose is negligible.

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Prolongation of Na Channel INACTIVATION

Sodium Valproate
Carbamazepine
Phenytoin
Topiramate
Zonisamide
Lamotrigine

Shit Crap, Phinease Took Zoo Lamps

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Inhibition of Ca Channel Current

Sodium Valproate
Ethosuzimide
Trimethadione

SET (inhibiting anyone coming in)

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Faciliation of GABA mediated Cl Channel Opening

Barbiturate
Benzodiazepine
Vigabatrin
Sodium Valproate
Gabapentin
Tiagabine

Ben and Barb, So Very Good Tia

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Organ Systems Effected by CHRONIC XS USE

CNS Effects
- Addiction
- Wernicke-Korsakoff Syndrome
- Cortical Atrophy/Dementia

Hepatic/Pancreatic
- Steatosis (Fatty Liver)
- Alcoholic hepatitis
- Cirrhosis
- Pancreatitis

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Sensitization

Increased response to a drug with repeated use Shifting Dose Response Curve to the left

Tolerance

a state of adaptation in which
exposure to a drug induces changes that
result in a diminution of one or more of the
drug’s effect over time
Shifting Dose Response Curve to the right

Addiction

a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations

Drug Abuse

maladaptive pattern of substance use characterized by repeated adverse consequences related to the repeated use of the substance

Dependence

Body adapts to presence of drug. Needs drug on board to maintain homeostasis

Sublocade Clinical Benefits of SQ injection once a month

- Reducing the diversion and abuse/nonmedical use when compared to SL tablet or film form - Useful in noncompliant patients because no need to take a SL tablet or film once or twice a day

Sublocade BBW

Serious harm or death if admin IV/IM because it forms a block upon contact with body fluids HENCE REMS PROGRAM

Sublocade admin doses ____days apart

Stimulants Examples

Cocaine Amphetamine Methamphetamine PCP Ketamine

Eletriptan CP

CI in potent CYP3A4 inhibitors needs 72hrs washout (like ketoconazole, clarithromycin, Nafazidome, and ritonavir) Most lipophilic (can cross the BBB so more CNS Effects, but less recurrence)

Frovatriptan CP

Longest half life, ONLY TRIPTAN OKAY FOR PREVENTION IN MENSTRUAL HEADACHES

Sumatriptan CP

Intranasal, SQ, and PO formulations Intranasal >> SQ > PO for onset of action Sumatriptan chest pain is most common with SQ, so just change to a different formulation if it's a side effect issue

CGRP Mabs

Eptinezumab Erenumab Fremanezumab Galcanezumab

Which of the CGRP mabs are a CGRP receptor?

Erenumab, others are CGRP ligands

Eptinezumab Route of Administration and freq

IV q 3 months

Erenumab Route of Administration and freq

SQ every month

Fremanezumab Route of Administration and freq

SQ every month OR every 3 months

Galcanezumab Route of Administration and freq

SQ every month

Eptinezumab side effects

infusion reaction Nasopharyngitis Nausea

Erenumab side effects

Injection site reaction Constipation*** if its really bad may need to be hospitalized, consider if there are other drugs on board that are causing low GI motility

Fremanezumab side effects

injection site reaction

Galcanezumab side effects

injection site reaction

Magnesium use and ADE

migraine prophylaxis, rec in prego ADE: Diarrhea, N/V

Feverfew use and ADE

migraine prophylaxis, AVOID IN PREGO BECAUSE MAY CAUSE UTERINE CONTRACTIONS AND ABORTIONS ADE: GI issues (stomach pain, bloating, constipation, diarrhea, flatulence, heartburn, nausea)

Butterbur use and ADE

migraine prophylaxis AVOID PRODUCTS THAT ARE NOT LABELED AS PA FREE (PYRROLIZIDINE ALKALOIDS) ADE: GI issues (belching, diarrhea, stomach upset), drowsy, fatigue, pruritus, rash, hepatotoxicity (rare)

Botox use, BBW, ADE

for Chronic migraines BBW: Spread of toxin effect - muscle weakness, diplopia (double vision), ptosis (eyelid drooping), dysphagia (can't swallow), breathing issues ADE: injection site pain, neck pain, myalgia (muscle pain), facial paresis (face paralysis)

Lasmiditan clinical pearl and ehat level of control?

C5 And must wait 8hrs between dosing and driving heavy machinery because of profound cns depression

Topiramate ADE

Cognitive dysfunction CNS Effects Nephrolithiasis Metabolic acidosis Angle closure glaucoma Oligohydrosis/hyperthermia (no sweating) Suicidal ideation

Sodium valproate BBW

Hepatotoxicity Pts with mitochondrial disease Fetal risk Pancreatitis

Tricyclic antidepressants use and ade

Used in preventative migraine TX, #4 Ade, anticholinergic effects, cardiac conduction abnormalities

Opioid effects of use

Euphoria Dysphoria Apathy Motor retardation Sedation Slurred speech Attention impairment Miosis Constipation